Forests for the Future:
Family Planning in
Nepal’s Terai Region
By Leona D’Agnes, Judy Oglethorpe,
Sabita Thapa, Dhan Rai, and
Tara Prasad Gnyawali
A transformation is taking place in the Khata
areas of rural Nepal: People dependent on forests
are learning new ways to protect the source of their
livelihoods. Farmers are now the front-line stewards
of the environment—and enthusiastic advocates for
integrating population-health-environment (PHE) programs into their community activities.
“Family planning and health issues have become an integral part of our community forestry program. Prior to the
introduction of the population, health, and environment concept,
we hardly had any clue on the linkages between forest management
and family planning. Now we work hard to conserve forest
resources and are encouraging everyone to use alternative
energy and family planning so there will be forest left
for future generations,” says Krishna Pariyar, secretary of Khata Community Forestry Coordination
Committee, a consortium of community-based
organizations that manage a swath of forest
within Nepal’s Terai region.
John Pielemeier

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FOCUS on population, environment, and security
Poverty and Population Dynamics
in Nepal

Despite significant improvements in economic and
social indicators over the past two decades, Nepal
remains among the poorest countries in the world
(ADB, 2007). The vast majority of Nepalese live in
rural areas, where they depend upon agriculture for
their livelihoods and suffer almost double the rate
of poverty (44 percent) of their urban counterparts
(ADB, 2001).
In less than a century, Nepal’s population
increased more than five-fold, to 27 million people
(PRB, 2008). Population density is high in the fertile river plain known as the Terai, where 48 percent
of the country’s population lives in 17 percent of
its total land mass (CBS, 2001). Due to high birth
rates and internal migration from the highlands,
the Terai registered the highest regional population
growth rate (2.86 percent) in the 2001 census, significantly higher than the nationwide annual growth
rate of 2.1 percent (CBS, 2001; PRB, 2008). The
high birth rates are largely due to early marriage (42

percent of Nepalese girls aged 15-19 are married),
which has a cumulative effect on fertility (De Silvade Alwis, 2008).

Forests and Biodiversity Under
Threat: Nepal’s Terai Region
The majority of Nepal’s population is heavily
dependent on the country’s natural resources, especially its forests. However, this essential resource has
declined dramatically since the 1950s, and deforestation continues. Between 1990 and 2005, Nepal
lost 1.2 million hectares, or about 25 percent of its
total forest cover (FAO, 2005). Grazing, human
settlement, and firewood collection are the major
threats to the forest. Almost 80 percent of Nepalese
rely on firewood for heating and cooking, and most
still use inefficient traditional stoves (WWF-Nepal,
2006). Many people graze their livestock in forests,
which are also used for food, animal fodder, building materials, medicine, and income generation.
Nepal is a treasure trove of biodiversity: Its 0.1
percent of the world’s landmass hosts 2 percent of
the world’s flower species, 4 percent of its mammal
species, and 8 percent of its bird species (MOPE,
2001). The Terai is home to flagship species such
as the Bengal tiger, wild Asian elephant, and greater one-horned rhinoceros. Seventy-five percent of
lowland Nepal’s remaining forests are in the Terai
(EOE, 2007). But this unique biodiversity is under
threat: A recent study examining the causes of biodiversity loss in the Terai forests concluded that
population growth was the most serious factor
(Montayne, 2003).
To stem these losses, Nepal was one of the first
developing countries to adopt community forest management, which promotes better management by shifting control of forests from the government to the local communities that use them.
Community groups of forest users charge membership fees, levy fines, and sell non-timber forest
products in order to finance their operating budgets
and fund development projects. Thirteen thousand
user groups, which manage 1.6 million hectares of
forest area across the country, have helped reduce
the deforestation rate in Nepal by 3.7–5.0 percent a
year (USAID, 2006).

Lessons From the First Generation of Integrated Population, Health, and Environment Projects

Issue 18 March 2009 Forests for the Future

FOCUS Online

www.wilsoncenter.org/ecspfocus

Livelihoods Outcomes: Study and Analysis of Changes in the Livelihoods of Bottleneck-Level Community Forest
Users, a WWF report, explores livelihood gains among residents of the Terai Arc Landscape:
http://assets.panda.org/downloads/wwf_livelihood_booklet_final__july8_08.pdf

Detailed maps of the Terai Arc Landscape project, other WWF-supported projects in Nepal, and protected areas around the country can be downloaded from WWF:
http://www.panda.org/about_wwf/where_we_work/asia_pacific/where/nepal/news/
maps_nepal/index.cfm

The Root Causes of Biodiversity Loss in the Terai Arc Landscape: An Exploration of Factors Affecting Biodiversity
Loss and the Relationship to Livelihoods, by Dawn Montayne:
http://assets.panda.org/downloads/finalrootcausesreportteraiarc1.pdf

At a March 2009 meeting at the Woodrow Wilson Center, Jon Miceler discussed WWF’s population,
health, and environment program in the Terai Arc Landscape, along with Rishi Bastakoti of Resource
Identification and Management Society Nepal:
http://tinyurl.com/nepalevent

Richard Matthew and Bishnu Raj Upreti explore the links between population growth, environmental degradation, and violent conflict in “Environmental Change and Demographic Change in Nepal:
Underlying Conditions Contributing to a Decade of Insurgency” in ECSP Report 11.
http://www.wilsoncenter.org/topics/pubs/Nepal_Env_Stress&Demo_Change.pdf

John Pielemeier

3

FOCUS on population, environment, and security

“Now we work hard to
conserve forest resources
and are encouraging
everyone to use alternative
energy and family
planning so there will
be forest left for future
generations.”

– Krishna Pariyar

Combining Conservation and
Health in the Khata Corridor
The Terai’s Khata corridor, which links Bardia
National Park in Nepal with India’s Katarniaghat
Wildlife Sanctuary, is a vital conduit for rhinoceroses, tigers, and elephants. It is also home to almost
25,000 people from indigenous groups, including
the Tharu, whose high population growth and large
average household size (7.1) have increased pressure
on the forest (WWF-Nepal, 2006).*
Communities in the corridor area are unusually
poor; the average per capita annual income is under
US$50, well below the national average of US$235
(WWF-Nepal, 2008). Diseases such as acute respiratory infections, pneumonia, typhoid, and tuberculosis are common. Poverty drives many men and
women to travel to India for seasonal work; these
migrant laborers are more susceptible to sexually
transmitted infections (including HIV/AIDS) while
away from their homes and families.
In 2003, WWF-Nepal and its local implementing partner, the Community Forestry Coordination

Committee, an umbrella organization of several
forest user groups, began to integrate health services
into ongoing conservation work in Khata, with support from Johnson & Johnson. Initially, the project
worked with the Nepal Red Cross Society, which
trained volunteers in first aid and helped establish
a community-run health clinic. The project raised
awareness about HIV/AIDS and family planning;
and improved the quality of sanitation and drinking water.
The Khata communities appreciated these health
activities, which helped build goodwill toward the
project’s partners and their conservation efforts—
particularly during Nepal’s civil war between the
government and the Maoist insurgency, when government health facilities were closed and local people, especially women and children, lacked reliable
access to health services and supplies. The project’s
low-profile activities were able to continue, since
the clinic and other health services were supplied at
the local level.
In addition, the health interventions contributed
directly to conservation. Households in this area
are so poor that a death or major illness can force

* All population and health data on the Khata corridor are calculated by WWF from data reported in the Nepal Demographic and
Health Survey (Ministry of Health and Population, New ERA, &
Macro International Inc., 2007).

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Lessons From the First Generation of Integrated Population, Health, and Environment Projects

Issue 18 March 2009 Forests for the Future

families to sell their land. Landless people are more
dependent on forest resources and may illegally
settle on forested land.
To reduce the pressure on forests, WWF and
partners tackled two other major threats: firewood
collection and cattle grazing. A revolving fund
provided loans to purchase biogas units and build
improved cookstoves, which curb deforestation
and reduce exposure to indoor air pollution. WWF
worked with communities to remove cattle from
the forest and replace them with a smaller number of stall-fed cows, which produce dung for the
biogas digesters; provide milk that improves child
nutrition; and boost household income through
the sale of surplus milk (Oglethorpe, Honzak, &
Margoluis, 2008).
Yet despite the Khata projectâ&#x20AC;&#x2122;s health and
conservation successes, forest restoration efforts
were at risk because the population continued to
increase due to early marriage and childbearing, as
well as poor knowledge of family planning and low
contraceptive use. On average, women in the Terai
are 25 years of age and have three children before
they begin to use contraception (CEDPA, 2008).
The 2007 Demographic and Health Survey found
that 20.9 percent of currently married women (1549) living in the mid-western Terai region, which
includes the Khata corridor, have an unmet need
for family planning.

Integrating Population and Health
Into Forest Management
In 2006, USAID selected the Khata project to test
whether forest user groups could implement family planning services and education in tandem with
conservation, health, and sustainable livelihood
activities. USAID observed that user groups were
promising platforms for the introduction of PHE
services because they offered access to established
networks, training programs, and their own sources of funding.
In the pilot project, WWF partnered with the
Adventist Development and Relief Agency to train
field staff and volunteers to deliver family planning
services and education. Over a two-year period,

Root Causes
of Biodiversity Loss
in Terai Forests

Over-harvesting of trees for fuel
wood and timber: Increasing population,
coupled with the lack of affordable alternative
energy technologies, drives demand for fuel
wood and thus deforestation. The extremely high
dependency on wood for fuel also produces
indoor air pollution and respiratory problems.
Overgrazing of livestock: Increasing
population, combined with decreasing size of
land holdings per capita and the continued
popularity of raising livestock, will continue to
increase grazingâ&#x20AC;&#x2122;s impact on Nepalâ&#x20AC;&#x2122;s landscape.
Encroachment and settlement: As the
population grows, more forest is cleared for
cultivation. The conversion of forests to fields
increases soil erosion and flooding.
Source: Montayne (2003).

John Pielemeier

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FOCUS on population, environment, and security

Khata Corridor Map
CHINA

N

NEPAL

TAL - NEPAL

SHUKLAPHANTA
WILDLIFE RESERVE

Kathmandu

INDIA

Basanta Corridor
Mahendranagar

Kailali
Kanchanpur

NEPAL

BARDIA
NATIONAL PARK

Dhangadhi

Mahadevpuri
Bottleneck

Laljhadi Corridor

Bardia

Khata Corridor
WWF PHE Project Sites

Lamahi
Bottleneck

Gulariya

Nepalgunj

Banke

Pokhara

Dovan
Bottleneck

Dang

Lamahi

Legend

Kathmandu

Palpa
Butwal

Kapilvastu

Rupandehi

Narayangadh

Nawalparasi

Chitwan

Makwanpur

Protected Area
Hetauda

Buffer Zone

INDIA

TAL - Nepal District Boundary

CHITWAN NATIONAL PARK
PARSA
WILDLIFE RESERVE

Corridors Bottlenecks Restoration Project Site

0

45

90

Bara
Birganj

Rautahat

180
Kilometers

181 staff and volunteers helped the project roll out
PHE services to an estimated 22,000 people living
in 3,095 households. Activities included:
• Teaching illiterate women and girls about family
planning, reproductive health, and environmental issues;
• Educating youth and adults about safer sex
and using condoms to prevent HIV/AIDS and
unwanted pregnancy;
• Conducting media campaigns that explain the
connections between population, health, and the
environment;
• Promoting increased energy efficiency in the
home;

6

Parsa

• Improving monitoring and reporting of acute
respiratory infection cases among under-five children by female community health volunteers;
and
• Coordinating with workers at government health
centers to assure an adequate supply of family
planning products and to establish referral mechanisms for other services.

Successes of the PHE Approach
The PHE approach has helped transform people’s
attitudes toward family planning and improve their
understanding of its contribution to sustainable
livelihoods. Contraceptive use among couples in
Khata increased from 43 percent in September 2006

Lessons From the First Generation of Integrated Population, Health, and Environment Projects

Issue 18 March 2009 Forests for the Future

to 72.6 percent in September 2008 (WWF-Nepal,
2008). Interviews suggest that community members realize that limiting family size can contribute
to their continued prosperity. Whereas before they
viewed family planning solely as a means to better health, now they also call it a practice for “better management of their forest assets” (D’Agnes,
2007).
The project also increased the number of households adopting biogas and smokeless, fuel-efficient
cookstoves in Khata from 11 percent in 2006 to 19
percent in 2008, resulting in 1,524 metric tons of
firewood saved annually. Moreover, about 1,320
households installed solar lamps, which, according to users, resulted in “savings for their family”
from reduced expenditure for kerosene (D’Agnes,
2007). The project’s data show a reduction in the
incidence of severe cases of acute respiratory infection among under-five children living in the project
area, which suggests that the increased use of clean
energy technology has improved health conditions
in Khata.
Neighboring villages are now clamoring to share
these benefits. The Khata groups are helping their
neighbors meet government requirements to form
their own user groups to sustainably manage their
own natural resources.
Devi K.C., secretary of the Gauri forest user
group and a community-based distributor (CBD)
of family planning services and products, says that
clients, especially men, are now becoming more
comfortable talking to women distributors about
contraceptives. “Previously, people were reluctant to
speak about family planning. Now, women CBDs
who are more conversant and informed on reproductive health and family planning openly talk to
forest user groups about sexual and reproductive
health—and people listen to them,” says Devi.
She also sees great benefits from the peer education programs that encourage women to discuss
their reproductive health problems. For instance,
many local women suffer from prolapsed uteruses
caused by lifting and carrying heavy bundles of firewood. Despite the pain, women were reluctant to
talk about this problem until approached by peer
educators. Women and men in the community are
now trying to obtain government services to help
these women.

Acute respiratory infection (ARI)—
often caused by smoke and pollution from
indoor cooking fires—is a serious problem
for women and young children in Nepal. In
the Khata corridor, the WWF PHE project has
promoted biogas and improved cooking stoves
to help address this problem, as well as relieve
pressure on the forests and reduce the amount of
time women spend collecting firewood.
Biogas digesters are connected to household
latrines. Human waste, along with cattle dung,
produces biogas in the digester, which is piped
to the nearby kitchen and used for cooking.
A total of 586 households (19 percent) in Khata
are now using biogas or improved cookstoves,
saving an estimated 1,524 metric tons of
firewood annually (equivalent to about 3,800
trees). Women also report great savings in time
and work, allowing them to engage in forest
management and PHE activities organized by
their user groups.
Source: WWF-Nepal (2008).

John Pielemeier

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FOCUS on population, environment, and security
Strategy for Sustainability

“Now, women CBDs
who are more conversant
and informed on
reproductive health
and family planning
openly talk to forest user
groups about sexual and
reproductive health—and
people listen to them.”

– Devi K. C.

From the outset, the project required that NGO
partners and forest user groups contribute funds to
maximize the project’s long-term sustainability; to
date, these contributions total more than $37,500
over two years (compared to USAID’s contribution
of $80,000). WWF plans to phase out its financial
support of the Khata project, so sustaining the project’s conservation and health gains will be a challenge. But with the return of peace to Nepal, the
Ministry of Health has recently reopened the local
sub-health post three miles away, so the government will play a larger role in providing health care
to these communities.
WWF and the Khata Community Forestry
Coordination Committee worked with 24 user
groups to integrate family planning and clean
energy interventions into their five-year community forest operational plan amendments to ensure
that PHE activities will continue. WWF-Nepal has
also worked with Department of Forestry personnel
and educated them about the benefits of integrated
approaches to family planning, health, and community forestry management. The district forest
officials have indicated their support for the revised
operational plans (WWF-Nepal, 2008).

Conclusions and Recommendations
Based on WWF-Nepal’s experience, we offer the
following conclusions and recommendations for
programs seeking to integrate family planning and
reproductive health into forest management:
• Providing health and livelihood assistance
helps win a community’s trust and can simultaneously protect the environment. Access to
basic health services and family planning was a
priority in Khata. By responding to these needs,
WWF-Nepal and its partners were able to gain
the community’s trust and participation in conservation activities. This experience shows that
providing health and family planning services
linked to environmental activities not only
improves health, but can also help relieve environmental pressure.

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Lessons From the First Generation of Integrated Population, Health, and Environment Projects

Issue 18 March 2009 Forests for the Future

• Environmental NGOs can successfully promote
reproductive health and family planning in partnership with health organizations. Remote communities in areas of high biodiversity often lack
knowledge about family planning and how it contributes to sustainable livelihoods. Evidence from
this project shows that environmental NGOs can
quickly learn to facilitate such processes with appropriate partnerships, training, and support.
• PHE integration is fast and inexpensive. Integrating
family planning and health services into community
forest management programs can be achieved quickly and at relatively low cost. Because the Community
Forest Coordination Committee was already organized and adept at governance, the project saved
significant time and an estimated $10,000 that
otherwise would have been required to achieve the
same level of community mobilization. Leveraging
the user groups’ community development funds also
improved the project’s cost effectiveness.
• Partnering with natural resource management
groups helps health projects reach vulnerable
populations. Working with community organizations like forest user groups can add value to family
planning and health programs. Through this partnership, the project was able to promote family planning
in disadvantaged, difficult-to-reach communities as a
way to improve their livelihoods.
• Successful advocacy communication is key. By
demonstrating how PHE both improves health and
reduces vulnerability to poverty, the project was able
to catalyze the support and participation of forest
user groups. NGOs should include representatives
of their target audiences in the process of developing
key messages and identifying the best messengers.
• Partnering with user groups makes PHE projects
more sustainable. Communities that recognize that
rapid population growth threatens forest resources
are more likely to support family planning and reproductive health activities. Rather than creating a new
PHE project or agenda, NGOs should first look for
an existing natural resource management program
that could serve as a platform for implementing family planning and reproductive health initiatives.

Providing health and
family planning services
linked to environmental
activities not only

Lessons From the First Generation of Integrated Population, Health, and Environment Projects

Issue 18 March 2009 Forests for the Future

About the Authors
Leona D’Agnes is a PHE specialist and consultant to CDM International for integrating population and health into forest management agendas in Nepal.
Judy Oglethorpe is managing director of WWF-US’s People and Conservation program,
where she works on several environment-development issues, including health, population, livelihoods, conflict and security, and community adaptation to climate change.

Community foresters
in Khata (courtesy
Heather D’Agnes).

Sabita Thapa is environment advisor at the United Nations Development Programme in the
Solomon Islands. Previously, she worked for WWF-Nepal as the head of the Department of
Program Development and Fundraising. Her major interest is in community conservation.
Dhan Rai is the senior project manager in WWF for the Terai Arc Landscape, and managed
the PHE project in the Khata Corridor for several years.
Tara Prasad Gnyawali has been a livelihoods specialist with WWF-Nepal for the past four
years, focusing on mainstreaming livelihoods issues into conservation programs.
This report is made possible by the generous support of the American people through the United States Agency
for International Development’s (USAID) Office of Population and Reproductive Health. The contents are the
responsibility of Woodrow Wilson International Center for Scholars and do not necessarily reflect the views of
USAID or the United States Government. Views expressed in this report are not necessarily those of the Center’s
staff, fellows, trustees, advisory groups, or any individuals or programs that provide assistance to the Center.
Woodrow Wilson International Center for Scholars
Lee H. Hamilton, President and Director
Board of Trustees: Joseph B. Gildenhorn, Chair, Sander R. Gerber, Vice Chair
PUBLIC MEMBERS: James H. Billington, The Librarian of Congress; Hillary R. Clinton, The Secretary, U.S.
Department of State; G. Wayne Clough, The Secretary, Smithsonian Institution; Arne Duncan, The Secretary,
U.S. Department of Education; Chairman, National Endowment for the Humanities; The Secretary, U.S.
Department of Health and Human Services; Archivist of the United States
PRIVATE CITIZEN MEMBERS: Charles Cobb, Robin Cook, Charles L. Glazer, Carlos M. Gutierrez, Susan
Hutchison, Barry S. Jackson, Ignacio E. Sanchez

John Pielemeier

11

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